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Ultrasound halo sign as a potential monitoring tool for patients with giant cell arteritis: a prospective analysis
  1. Cristina Ponte1,2,
  2. Sara Monti3,4,
  3. Carlo Alberto Scirè5,6,
  4. Paolo Delvino3,
  5. Nikita Khmelinskii1,2,
  6. Alessandra Milanesi3,
  7. Vítor Teixeira1,7,
  8. Fabio Brandolino3,
  9. Fernando Saraiva1,
  10. Carlomaurizio Montecucco3,
  11. João Eurico Fonseca1,2,
  12. Wolfgang A Schmidt8,
  13. Raashid Ahmed Luqmani9
  1. 1 Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
  2. 2 Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
  3. 3 Rheumatology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
  4. 4 PhD in Experimental Medicine, University of Pavia, Pavia, Italy
  5. 5 Epidemiology Research Unit, Italian Society of Rheumatology, Milano, Italy
  6. 6 Department of Medical Sciences, Rheumatology Unit, University of Ferrara, Ferrara, Italy
  7. 7 Rheumatology Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal
  8. 8 Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
  9. 9 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Sara Monti, Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Lombardia, Italy; sara.saramonti{at}


Objectives To assess the sensitivity to change of ultrasound halo features and their association with disease activity and glucocorticoid (GC) treatment in patients with newly diagnosed giant cell arteritis (GCA).

Methods Prospective study of patients with ultrasound-confirmed GCA who underwent serial ultrasound assessments of the temporal artery (TA) and axillary artery (AX) at fixed time points. The number of segments with halo and maximum halo intima–media thickness (IMT) was recorded. Time points in which >80% of patients were assessed were considered for analysis. Halo features at disease presentation and first relapse were compared.

Results 49 patients were assessed at 354 visits. Halo sensitivity to change was assessed at weeks 1, 3, 6, 12 and 24 and showed a significant standardised mean difference between all time points and baseline for the TA halo features but only after week 6 for the AX halo features. The number of TA segments with halo and sum and maximum TA halo IMT showed a significant correlation with erythrocyte sedimentation rate (0.41, 0.44 and 0.48), C reactive protein (0.34, 0.39 and 0.41), Birmingham Vasculitis Activity Score (0.29, 0.36 and 0.35) and GC cumulative dose (−0.34, −0.37 and −0.32); no significant correlation was found for the AX halo features. Halo sign was present in 94% of first disease relapses but with a lower mean number of segments with halo and sum of halo IMT compared with disease onset (2.93±1.59 mm vs 4.85±1.51 mm, p=0.0012; 2.01±1.13 mm vs 4.49±1.95 mm, p=0.0012).

Conclusions Ultrasound is a useful imaging tool to assess disease activity and response to treatment in patients with GCA.

  • giant cell arteritis
  • ultrasonography
  • systemic vasculitis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Handling editor Josef S Smolen

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  • CP and SM contributed equally.

  • Correction notice This article has been corrected since it published Online First. The author affiliations have been amended.

  • Contributors All listed authors provided substantial contributions to this work. CP, SM, WS and RAL were involved in its conception and design. CP, SM, PD, NK, AM, VT, FB, FS, CM and JEF contributed to the acquisition of data. CAS conducted the statistical analyses. CP, SM, RAL and WS contributed to the interpretation of data. CP, SM, CAS and RAL drafted the manuscript. All authors contributed to the critical revision of the manuscript and agreed on its final version.

  • Funding CP’s work was supported in part by a grant from the Portuguese Society of Rheumatology.

  • Competing interests None declared.

  • Patient and public involvement statement Patients or the public were not involved in the design, conduct, reporting or dissemination plans of our research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.